Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review.
Annals of internal medicine
Chou R, Wasson N
2013 Ann. Intern. Med. Volume 158 Issue 11
PubMed 23732714 DOI 10.7326/0003-4819-158-11-201306040-00005
BACKGROUND
Many blood tests have been proposed as alternatives to liver biopsy for identifying fibrosis or cirrhosis.
PURPOSE
To evaluate the diagnostic accuracy of blood tests to identify fibrosis or cirrhosis in patients with hepatitis C virus (HCV) infection.
DATA SOURCES
MEDLINE (1947 to January 2013), the Cochrane Library, and reference lists.
STUDY SELECTION
Studies that compared the diagnostic accuracy of blood tests with that of liver biopsy.
DATA EXTRACTION
Investigators abstracted and checked study details and quality by using predefined criteria.
DATA SYNTHESIS
172 studies evaluated diagnostic accuracy. For identifying clinically significant fibrosis, the platelet count, age-platelet index, aspartate aminotransferase-platelet ratio index (APRI), FibroIndex, FibroTest, and Forns index had median positive likelihood ratios of 5 to 10 at commonly used cutoffs and areas under the receiver-operating characteristic curve (AUROCs) of 0.70 or greater (range, 0.71 to 0.86). For identifying cirrhosis, the platelet count, age-platelet index, APRI, and Hepascore had median positive likelihood ratios of 5 to 10 and AUROCs of 0.80 or greater (range, 0.80 to 0.91). The Göteborg University Cirrhosis Index and the Lok index had slightly lower positive likelihood ratios (4.8 and 4.4, respectively). In direct comparisons, the APRI was associated with a slightly lower AUROC than the FibroTest for identifying fibrosis and a substantially higher AUROC than the aspartate aminotransferase-alanine aminotransferase ratio for identifying fibrosis or cirrhosis.
LIMITATION
Only English-language articles were included, and most studies had methodological limitations, including failure to describe blinded interpretation of liver biopsy specimens and inadequate description of enrollment methods.
CONCLUSION
Many blood tests are moderately useful for identifying clinically significant fibrosis or cirrhosis in HCV-infected patients.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
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